Amy Moon Lancaster, MS, RD, LD
Individual provider Active NPI Registered Dietitian · Larue, TX
NPI 1295093201 · NPPES record last updated Apr 26, 2012
Key facts
- NPI
- 1295093201
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- DT06227 (TX)
- Practice address
- 19828 N Pine View TRL
Larue, TX 75770-6311 - Phone
- (903) 570-5588
- NPI assigned
- Apr 26, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT06227 | TX | MD | Registered Dietitian |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DT06227 | TX | Yes |
Addresses
Primary practice location
19828 N Pine View TRL
Larue, TX 75770-6311
Mailing address
19828 N Pine View TRL
Larue, TX 75770-6311
Phone (903) 570-5588
Other providers in Larue, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 26, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.